scholarly journals Subthreshold Micropulse Photocoagulation for Persistent Macular Edema Secondary to Branch Retinal Vein Occlusion including Best-Corrected Visual Acuity Greater Than 20/40

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Keiji Inagaki ◽  
Kishiko Ohkoshi ◽  
Sachiko Ohde ◽  
Gautam A. Deshpande ◽  
Nobuyuki Ebihara ◽  
...  

To assess the efficacy of subthreshold micropulse diode laser photocoagulation (SMDLP) for persistent macular edema secondary to branch retinal vein occlusion (BRVO), including best-corrected visual acuity (BCVA) > 20/40, thirty-two patients (32 eyes) with macular edema secondary to BRVO were treated by SMDLP. After disease onset, all patients had been followed for at least 6 months prior to treatment. Baseline Snellen visual acuity was used to categorize the eyes as BCVA ≤ 20/40 (Group I) or BCVA > 20/40 (Group II). Main outcome measures were reduction in central macular thickness (CMT) in optical coherence tomography (OCT) and BCVA at 6 months. In the total subject-pool at 6 months, BCVA had not changed significantly but CMT was significantly reduced. Group I exhibited no significant change in CMT at 3 months but exhibited significant reductions at 6 and 12 months. Group II exhibited a marginally significant reduction in CMT at 3 months and a significant reduction at 6 months. In patients with persistent macular edema secondary to BRVO, SMDLP appears to control macular edema with minimal retinal damage. Our findings suggest that SMDLP is an effective treatment method for macular edema in BRVO patients with BCVA > 20/40.

2018 ◽  
Vol 7 (3) ◽  
pp. 89-93
Author(s):  
Kiran Shakya ◽  
Ram Prasad Pokhrel ◽  
Om Krishna Malla

Background: Macular edema is the common sight-threatening condition following branch retinal vein occlusion. Objective: To find spectral domain optical coherence tomography characteristics of macular involvement and visual acuity in the patients with branch retinal vein occlusion Methodology: This is a cross-sectional study; consecutive new cases of branch retinal vein occlusion diagnosed at the ophthalmology department of Kathmandu Medical College, Kathmandu were carried out from November 2016 to October 2017. All subjects were divided three groups with normotensive/controlled hypertension, stage 1 hypertension (systolic pressure >140 mm Hg or diastolic pressure >90mm Hg) and Stage 2 hypertension (systolic pressure >160 mm Hg or diastolic pressure >100 mm Hg).The macular edema was evaluated by taking best corrected visual acuity and spectral domain optical coherence tomography for measurement of central foveal thickness. Results: Forty patients with forty eyes were enrolled. Mean age was 58.5 years SD ± 9.98 years. Stage 1 and stage 2 hypertensive groups had significantly worse best corrected visual acuity and more thickness of central foveal thickness than normotensive/controlled group (p<0.001). The best corrected visual acuity and central foveal thickness were successively worse among normotensive group, stage 1 hypertensive group and stage 2 hypertensive group (between normotensive/controlled group and stage 1 hypertensive group, p = 0.032 and 0.002 respectively and between stage I hypertensive group and stage 2 hypertensive group, p= 0.013 and 0.09 respectively). Conclusion: Control of hypertension could be a main contributing measure to lower incidence of branch retinal vein occlusion and the severity of macular edema.


2018 ◽  
Vol 28 (6) ◽  
pp. 697-705 ◽  
Author(s):  
Francesco Bandello ◽  
Albert Augustin ◽  
Adnan Tufail ◽  
Richard Leaback

Purpose: Dexamethasone intravitreal implant and intravitreal ranibizumab are indicated for the treatment of macular edema secondary to retinal vein occlusion. This non-inferiority study compared dexamethasone with ranibizumab in patients with branch retinal vein occlusion. Methods: In this randomized, 12-month head-to-head comparison, subjects with branch retinal vein occlusion were assigned to dexamethasone 0.7 mg at day 1 and month 5 with the option of retreatment at month 10 or 11, or ranibizumab 0.5 mg at day 1 and monthly through month 5 with subsequent as-needed injections at month 6–month 11. The primary efficacy outcome was the mean change from baseline in best-corrected visual acuity at month 12; secondary outcomes included average change in best-corrected visual acuity, proportion of eyes with ≥10- and ≥15-letter gain/loss, change in central retinal thickness, and change in Vision Functioning Questionnaire-25 score. Results: In all, 307 of a planned 400 patients were enrolled in the study and received (mean) 2.5 dexamethasone injections (n = 154) and 8.0 ranibizumab injections (n = 153) over 12 months. The mean change from baseline in best-corrected visual acuity at month 12 was 7.4 letters for dexamethasone versus 17.4 letters for ranibizumab (least-squares mean difference (dexamethasone minus ranibizumab), −10.1 letters; 95% confidence interval, −12.9, −7.2; p = 0.0006). Conclusion: Dexamethasone and ranibizumab improved best-corrected visual acuity and anatomical outcomes; however, dexamethasone did not show non-inferiority to ranibizumab in this under-powered study. Dexamethasone was associated with an increased risk of intraocular pressure elevation and cataract progression, but a lower injection burden, compared to ranibizumab.


2014 ◽  
Vol 233 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Thomas C. Kreutzer ◽  
Armin Wolf ◽  
Martin Dirisamer ◽  
Rupert W. Strauss ◽  
Paul Foerster ◽  
...  

Purpose: This is a prospective, randomized, multicenter, investigator-initiated trial to evaluate the 12-month effectiveness of isovolemic hemodilution (IH) with prompt versus deferred intravitreal injections (IVI) of ranibizumab 0.5 mg for the treatment of macular edema secondary to early central retinal vein occlusion (CRVO). Methods: Eyes with macular edema due to CRVO having occurred not more than 8 weeks previously received either monthly ranibizumab IVI in combination with IH (group I, n = 28) or IH alone (group II, n = 30). From month 2 to 12, the patients in both groups could be treated with monthly intravitreal ranibizumab. The main outcome variables were gain of visual acuity and the course of central retinal thickness as measured with optical coherence tomography. Results: At 12 months, eyes in group I on average gained +28.1 (±19.3) letters compared to +25.2 (±20.9) letters in group II (p = 0.326). This result was achieved with significantly fewer injections in group II. Additionally, 30% of the eyes in group II did not need ranibizumab IVI during the 12 months of the trial. Conclusion: Ranibizumab IVI in addition to IH proved to be highly effective in increasing visual acuity and reducing macular edema secondary to CRVO. Initial IH in early CRVO may be a first treatment option in patients anxious about IVI.


2021 ◽  
Vol 38 (1) ◽  
Author(s):  
Irfan Muslim ◽  
Nasir Chaudhry ◽  
Rana Muhammad Mohsin Javed

Purpose:  To find out the effect of suprachoroidal Triamcinolone injection on best corrected visual acuity (BCVA) and central retinal thickness (CRT) in patients with macular edema secondary to retinal vein occlusion. Study Design:  Interventional case series. Place and Duration of Study:  College of Ophthalmology and Allied vision Sciences, Ophthalmology department, Unit II Mayo hospital, Lahore, from September 2019 to January 2020. Methods:  This study included 45 patients diagnosed with unilateral, retinal vein occlusion associated with macular edema. Patients with previous anti-vascular endothelial growth factor injection or any steroid injection received in the last 3 months or macular edema due to any other cause were excluded from the study. Only one eye of each patient was enrolled. The patients were treated with suprachoroidal triamcinolone injection (4 mg/100µL concentration). Patients with baseline central retinal thickness (CRT) of > 300 µm were included in the study. Serial changes in this parameter were evaluated at 1 week, 1 month and 3?months after suprachoroidal triamcinolone injection. Final CRT and Best-corrected visual acuity (BCVA) was recorded after three months. Results:  Out of 45 patients, 26 (57.7%) were males and 19 (42.2%) were females. Majority of the patients (35.4%) were 51–60 years old. During first week the visual acuity was 0.321 ± 0.273 LogMAR, after one month it was 0.468 ± 0.291 and 0.406 ± 0.318 after 03 months with a p value of 0.003. After three months significant decrease in CRT was observed. With a p-value of 0.002. Conclusions:  Suprachoroidal injection significantly improves BCVA and decreases CRT in patients with macular edema due to retinal vein Occlusion. Keywords:  Retinal vein occlusion, suprachoroidal injection, triamcinolone acetonide.


2005 ◽  
Vol 15 (5) ◽  
pp. 619-626 ◽  
Author(s):  
H.K. Tewari ◽  
P. Sony ◽  
R. Chawla ◽  
S.P. Garg ◽  
P. Venkatesh

Purpose To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and macular thickness using optical coherence tomography (OCT) in macular edema associated with various retinal vascular disorders. Methods This prospective nonrandomized clinical interventional study included 81 eyes (76 patients) comprised of Group I, 57 eyes (51 patients) with diabetic macular edema; Group II, 10 eyes (10 patients) with branch retinal vein occlusion; and Group III, 13 eyes (13 patients) with central retinal vein occlusion. All eyes received an intravitreal injection of 4 mg triamcinolone acetonide (with the solvent) in the operation theater under sterile conditions. Results Mean preinjection central macular thickness was 531.84±132 μm in Group I, 458.4±149 μm in Group II, and 750.81±148 μm in Group III. All groups showed a statistically significant decrease in mean central macular thickness at 1 month (300.7±119 μM in Group I, 218.2±99 μm in Group II, and 210.5 ±56 μm in Group III) and 3 months (253.19±109 μm in Group I, 187±47 μm in Group II, and 182±50 μm in Group III) after injection (p<0.05). Mean follow-up was 22±2.4 weeks. Mean visual acuity increased in all three groups (preoperative visual acuity in Group I, 1.2±0.4 logMAR units; Group II, 1.24±0.5 logMAR units; Group III, 1.1 ±0.4 logMAR units; 1 month postinjection in Group I, 0.88±0.3 logMAR units; Group II, 0.67±0.3 logMAR units; Group III, 0.86±0.4 logMAR units; 3 months postinjection in Group I, 0.84±0.4 logMAR units; Group II, 0.59±0.3 logMAR units; Group III, 0.82±0.5 logMAR units) (p<0.05). Forty-one eyes completed 6 months and 20 eyes completed 9 months follow-up. Twelve of 20 (41%) eyes in Group I, 2/6 (33%) eyes in Group II, 3/6 (50%) eyes in Group III, and 8/15 (53%) eyes in Group I, 1/3 (33%) eyes in Group II, and 2/2 (100%) eyes in Group III developed recurrence of macular edema with worsening of visual acuity at 6 and 9 months, respectively. Thirty-three (40.7%) eyes developed IOP elevation (at least one reading > 24 mmHg). One eye developed infective endophthalmitis. Conclusions Intravitreal injection of triamcinolone acetonide may be considered as an effective treatment for reducing macular thickening due to diffuse diabetic macular edema, venous occlusion associated macular edema, and may result in increase in visual acuity at least in the short term. Further follow-up and analysis is required to demonstrate its long-term efficacy.


2020 ◽  
Vol 9 (8) ◽  
pp. 2360
Author(s):  
Yusuke Arai ◽  
Hidenori Takahashi ◽  
Satoru Inoda ◽  
Shinichi Sakamoto ◽  
Xue Tan ◽  
...  

Purpose: To assess the efficacy and safety of a modified treat-and-extend (mTAE) regimen of aflibercept for macular edema (ME) due to branch retinal vein occlusion (BRVO). Methods: This prospective multicentre intervention study evaluated 50 eyes of 50 patients enrolled from October 2016 to September 2017. The patients received intravitreal aflibercept (IVA) injections on an mTAE regimen for a total of 12 months. The main outcome measures were best-corrected visual acuity (BCVA) and central subfield thickness (CST) at 12 months. Results: The baseline BCVA and CST were 0.33 (0.27) and 488 (171) µm (mean (standard deviation)), respectively. The BCVA and CST were significantly improved at month 12 (0.067 (0.19) LogMAR and 295 (110) µm; both p < 0.0001, paired t-test). The mean number of clinic visits and IVA injections was 6.71 (1.41) and 4.26 (0.71), respectively. The time to first recurrence from the first injection was most frequently 3 months. Conclusion: The mTAE regimen of IVA injections for ME due to BRVO effectively improved BCVA and reduced CST, and thus might be an effective therapy to reduce the number of injections and visits.


2017 ◽  
Vol 8 (1) ◽  
pp. 271-278 ◽  
Author(s):  
Thomas Bertelmann ◽  
Hans Ulrich Frank ◽  
Hendrik Ansgar Fuchs ◽  
Nicolas Feltgen

Purpose: To report a case with ischemic macular edema (ME) due to an acute branch retinal vein occlusion (BRVO) which was treated with repeated intravitreal anti-VEGF injections. Methods: Retrospective case presentation. Results: A 66-year-old female patient was treated with repeated intravitreal anti-VEGF injections due to ischemic ME following an acute BRVO. Over a period of 2.5 years best corrected visual acuity increased from 0.06 to 0.6 (decimal notation) accompanied by a reduction in central retinal thickness from 546 to 292 µm. Overall 17 anti-VEGF injections were administered to treat repeated recurrence of ME. Macular ischemia did not worsen during this profound intravitreal anti-VEGF therapy. Conclusion: Intravitreal anti-VEGF therapy can be a beneficial treatment strategy even in ischemic ME following an acute BRVO.


2015 ◽  
Vol 68 (9-10) ◽  
pp. 295-300
Author(s):  
Jelena Karadzic ◽  
Igor Kovacevic ◽  
Jelena Ljikar ◽  
Zorka Grgic ◽  
Gordana Devecerski

Introduction. Macular edema is the main cause of visual loss in patients with branch retinal vein occlusion. Macular edema is initially reversible, but over time, permanent loss of vision occurs from structural damage to the macula. For this reason, there is a need for more rapid and effective treatments than laser photocoagulation which has been established as a gold standard. There are several pharmacologic agents which have changed the management of macular edema. Material and Methods. Twenty eyes of 20 consecutive patients of the Department of Eye Diseases, Clinical Center of Vojvodina, in Novi Sad, were enrolled in this prospective, randomized and consecutive study conducted from January 2012 to January 2013. The patients were randomly assigned into two treatment groups, and they were given an intravitreal injection of bevacizumab 1.25 mg/0.05 mL (Avastin?), or triamcinolone acetonid injection 4 mg/0.1mL (Kenalog?). Reinjections were performed according to the following retreatment criteria a loss of visual acuity or increase in central retinal thickness. Results. Both intravitreal bevacizumab and triamcinolonacetonid were very effective in reducing macular edema and improving visual acuity in the eyes with macular edema secondary to retinal vein occlusion. The effect of the treatment was more pronounced if it started early after the onset of macular edema. The reported temporary effects of intravitreal triamcinolon- acetonide and bevacizumab could be explained by their clearance from the eye. Conclusion. The short-term results of our clinical trial showed that pharmacological intravitreal agents, such as bevacizumab and triamcinolon-acetonid, lead to rapid resolution of macular edema and significant improvement of visual acuity.


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